Closed by covid-19
The struggle to save lives and the economy is likely to present agonising choices
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PLANET EARTH
is shutting down. In the struggle to get a grip on covid-19, one
country after another is demanding that its citizens shun society. As
that sends economies reeling, desperate governments are trying to tide
over companies and consumers by handing out trillions of dollars in aid
and loan guarantees. Nobody can be sure how well these rescues will
work.
But
there is worse. Troubling new findings suggest that stopping the
pandemic might require repeated shutdowns. And yet it is also now clear
that such a strategy would condemn the world economy to grave—perhaps
intolerable—harm. Some very hard choices lie ahead.
Barely
12 weeks after the first reports of people mysteriously falling ill in
Wuhan, in central China, the world is beginning to grasp the pandemic’s
true human and economic toll. As of March 18th SARS-CoV-2,
the virus behind covid-19, had registered 134,000 infections outside
China in 155 countries and territories. In just seven days that is an
increase of almost 90,000 cases and 43 countries and territories. The
real number of cases is thought to be at least an order of magnitude
greater.
Spooked, governments are
rushing to impose controls that would have been unimaginable only a few
weeks ago. Scores of countries, including many in Africa and Latin
America, have barred travellers from places where the virus is rife.
Times Square is deserted, the City of London is dark and in France,
Italy and Spain cafés, bars and restaurants have bolted their doors.
Everywhere empty stadiums echo to absent crowds.
It has become clear that the economy is taking a much worse battering than analysts had expected (see Briefing).
Data for January and February show that industrial output in China,
which had been forecast to fall by 3% compared with a year earlier, was
down by 13.5%. Retail sales were not 4% lower, but 20.5%. Fixed-asset
investment, which measures the spending on such things as machinery and
infrastructure, declined by 24%, six times more than predicted. That has
sent economic forecasters the world over scurrying to revise down their
predictions. Faced with the most brutal recession in living memory,
governments are setting out rescue packages on a scale that exceeds even
the financial crisis of 2007-09 (see leader).
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This
is the backdrop for fundamental choices about how to manage the
disease. Using an epidemiological model, a group from Imperial College
in London this week set out a framework to help policymakers think about
what lies ahead. It is bleak.
One
approach is mitigation, “flattening the curve” to make the pandemic less
intense by, say, isolating cases and quarantining infected households.
The other is to suppress it with a broader range of measures, including
shutting in everybody, other than those who cannot work from home, and
closing schools and universities. Mitigation curbs the pandemic,
suppression aims to stop it in its tracks.
The
modellers found that, were the virus left to spread, it would cause
around 2.2m deaths in America and 500,000 in Britain by the end of
summer. In advanced economies, they concluded, three months of
curve-flattening, including two-week quarantines of infected households,
would at best prevent only about half of these. Moreover, peak demand
for intensive care would still be eight times the surge capacity of
Britain’s National Health Service, leading to many more deaths that the
model did not attempt to compute. If that pattern holds in other parts
of Europe, even its best-resourced health systems, including Germany’s,
would be overwhelmed.
No wonder
governments are opting for the more stringent controls needed to
suppress the pandemic. Suppression has the advantage that it has worked
in China. On March 18th Italy added 4,207 new cases whereas Wuhan
counted none at all. China has recorded a total of just over 80,000
cases in a population of 1.4bn people. For comparison, the Imperial
group estimated that the virus left to itself would infect more than 80%
of the population in Britain and America.
But
that is why suppression has a sting in its tail. By keeping infection
rates relatively low, it leaves many people susceptible to the virus.
And since covid-19 is now so widespread, within countries and around the
world, the Imperial model suggests that epidemics would return within a
few weeks of the restrictions being lifted. To avoid this, countries
must suppress the disease each time it resurfaces, spending at least
half their time in lockdown. This on-off cycle must be repeated until
either the disease has worked through the population or there is a
vaccine which could be months away, if one works at all.
This
is just a model, and models are just educated guesses based on the best
evidence. Hence the importance of watching China to see if life there
can return to normal without the disease breaking out again. The hope is
that teams of epidemiologists can test on a massive scale so as to
catch new cases early, trace their contacts and quarantine them without
turning society upside down. Perhaps they will be helped by new drugs,
such as a Japanese antiviral compound which China this week said was
promising.
But this is just a hope, and
hope is not a policy. The bitter truth is that mitigation costs too
many lives and suppression may be economically unsustainable. After a
few iterations governments might not have the capacity to carry
businesses and consumers. Ordinary people might not tolerate the
upheaval. The cost of repeated isolation, measured by mental well-being
and the long-term health of the rest of the population, might not
justify it.
In the real world there are
trade-offs between the two strategies, though governments can make both
more efficient. South Korea, China and Italy have shown that this
starts with mass-testing. The more clearly you can identify who has the
disease, the less you must depend upon indiscriminate restrictions.
Tests for antibodies to the virus, picking up who has been infected and
recovered, are needed to supplement today’s which are only valid just
before and during the illness (see article). That will let immune people go about their business in the knowledge that they cannot be a source of further infections.
A
second line of attack is to use technology to administer quarantines
and social distancing. China is using apps to certify who is clear of
the disease and who is not. Both it and South Korea are using big data
and social media to trace infections, alert people to hotspots and round
up contacts. South Korea changed the law to allow the state to gain
access to medical records and share them without a warrant. In normal
times many democracies might find that too intrusive. Times are not
normal.
Last, governments should invest
in health care, even if their efforts take months to bear fruit and may
never be needed. They should increase the surge capacity of intensive
care. Countries like Britain and America are desperately short of beds,
specialists and ventilators. They should define the best treatment
protocols, develop vaccines and test new therapeutic drugs. All this
would make mitigation less lethal and suppression cheaper.
Be
under no illusions. Such measures might still not prevent the pandemic
from extracting a heavy toll. Today governments seem to be committed to
suppression, whatever the cost. But if the disease is not conquered
quickly, they will edge towards mitigation, even if that will result in
many more deaths. Understandably, just now that is not a trade-off any
government is willing to contemplate. They may soon have no choice. ■
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This article appeared in the Leaders section of the print edition under the headline "Closed"
